What's the Best Heart Attack Treatment?
Common Practice of Giving Clot-Busters Before Balloon Angioplasty Questioned
Sept. 7, 2005 -- Giving
to heart attack
victims who are scheduled for could
cost them their lives, new research shows.
In a study of more than 1,600 people, those who were given a clot-busting
drug before angioplasty were nearly 40% more likely to die in the next month
than those who got angioplasty alone.
The study, presented Tuesday at the annual meeting of the European Society
of Cardiology, showed that 6% who were given the clot-buster TNKase before
angioplasty died vs. 4% who got angioplasty alone.
The trial was halted early due to the surprising excess death rate in
patients given the clot-buster, says Frans Van de Werf, MD, chairman of the
cardiology department of the University Hospital Gasthuisberg in Leuven,
"We're not sure what is going on," he tells WebMD. "Could we
have unwittingly sent the people in the [clot-buster] group to more experienced
doctors or more experienced hospitals? We just don't know."
'Message' Is Clear
De Werf says he hopes that final study results, scheduled to be released in
November at the annual meeting of the American Heart Association, will help
shed more light on the issue.
Raymond Gibbons, MD, professor of cardiology at the Mayo Clinic in
Rochester, Minn., tells WebMD that the findings are clear: Doctors who are
giving clot-busters to heart attack victims scheduled for angioplasty in the
next few hours should stop using the drugs. People in the study got angioplasty
one to three hours after symptoms began.
At the same time, Gibbons stresses, there is still a huge role for
clot-busters in treating heart attack victims.
Though angioplasty is considered a better option if it is performed by
experienced doctors at well-equipped hospitals, most rural and community
hospitals do not have such expertise, he explains. In such cases, clot-busters
"Right now, one in four heart attack victims who are candidates for
clot-busters or angioplasty get neither one," he says. "If you think
you are having a heart attack, call 911 - immediately."